心胸外科术后使用体外膜肺氧合治疗重度心肺功能不全23例临床分析

目的 分析我院成人心胸外科术后患者应用体外膜肺氧合（ECMO）治疗的临床资料，总结ECMO治疗经验及其相关并发症的防治措施。方法 回顾性分析2016年1月至2020年6月在上海交通大学医学院附属新华医院心胸外科术后因心肺功能不全行ECMO治疗的23例患者的临床资料，其中男性16例，女性7例，年龄64.5±8.9岁。瓣膜手术7例，冠状动脉旁路移植术5例，瓣膜合并冠状动脉旁路移植术5例，主动脉手术3例，食管手术3例。19例行静脉-动脉ECMO，4例行静脉-静脉ECMO。结果 ECMO辅助时间106～245h，平均（167±39）h。13例患者顺利撤除ECMO（脱机率56.5%），康复出院9例（39.1%），10例患者不能脱机或放弃治疗而死亡，撤机后院内死亡4例。死亡原因包括感染，继发性多器官功能衰竭，脑梗塞等。ECMO治疗相关并发症发生率82.6%（19/23），出血和肾功能不全是最常见的并发症。结论 ECMO对于心胸外科术后循环呼吸功能衰竭患者是一种重要的支持治疗手段，积极预防治疗并发症，对每个病人进行个体化治疗，精细化管理是提高ECMO疗效的关键。

Clinical analysis of 23 patients undergoing extracorporeal membrane oxygenation post cardiothoracic surgery

Objective To analyze the clinical data of patients using extracorporeal membrane oxygenation (ECMO) post cardiothoracic surgery in our hospital, and summarize the experiences during the treatment, as well as prevention and management of associated complications. Methods Twenty-three patients who underwent extracorporeal membrane oxygenation therapy post cardiothoracic surgery from January 2016 to June 2020 were retrospectively reviewed. There are 16 males and 7 females, and the mean age was 64.5±8.9 years. The initial operations include 7 valve surgeries, 5 isolated coronary bypass surgeries, 5 combination surgeries of valve and coronary bypass, 3 aortic surgeries, and 3 esophageal surgeries. Arterial-venous ECMO was used in 19 patients, while venous-venous ECMO was used in the other 4 patients. Results The average ECMO running time was 167±39 hours (range 106-245). ECMO was successfully weaned off in 13 patients (56.5%), but the other 10 patients were withdrawn because they were not able to wean off. In total, 9 patients survived to discharge (39.1%), and 4 patients died after weaning off ECMO. The causes of death included infection, multiple organ failure, and cerebral infarction et al. ECMO related complications were found in 19 patients (82.6%). Bleeding and renal failure were the main complications. Conclusion ECMO is an important therapeutic option in patients who develop circulatory and respiratory failure after cardiothoracic surgery. Prompt prevention of complications, individualized treatment, and refined management are key roles to improve outcomes in such patients.